Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

  • • Account for 1.5% of GI tract cancers

    • Usually long history of perianal complaints

    • Disease may be quite extensive at presentation

    • Associated with chronic anal infection (human papillomavirus)

    • Tumors anatomically found from the upper to lower border of the internal anal sphincter, 6-12 mm above dentate line

    • Referred to as epidermoid carcinoma


  • • Women are at increased risk

    • Homosexual males at greatly increased risk

    • 7/106 men; 9/106 women

    • Increased incidence in males and females practicing anal sex

    • Increased risk with history of anogenital warts; STD; > 10 sexual partners; cervical, vulvar, or vaginal cancer

    • Increased incidence in persons who smoke or who are immunosuppressed (HIV infection and transplantation)

Symptoms and Signs

  • • Perianal irritation, may be long-standing

    • Palpable mass, may be indurated

    • Bleeding

    • Itching

    • Tenesmus

Laboratory Findings

  • • No specific abnormalities

Imaging Findings

  • CT/MRI: Reveal anal mass

    Endorectal US: Reveals size and depth of invasion and perianal nodes

  • • Tumor of anal margin

    • Hemorrhoids

    • Anal melanoma

    • Perianal/perirectal abscess/fistula

    • Low rectal cancer

Rule Out

  • • Extension of low rectal adenocarcinoma

    • Anal melanoma

  • • Physical exam with digital rectal exam

    • Assessment for lymphadenopathy (groins)

    • Exam under anesthesia, anoscopy with biopsy

    • Endorectal US to assess size and depth of invasion

    • Chest film, CT to assess for metastatic disease

When to Admit

  • • Severe bleeding with hemodynamic compromise

    • Intractable symptoms: itching, pain

  • • Chemoradiation is mainstay of therapy

    • Role of surgery limited

    • Overall reported recurrence rates with local excision high



  • • Local excision for small, well-differentiated, mobile lesions confined to the submucosa

    • Surgery is largely used as salvage procedure or for recurrent/persistent disease (abdominal perineal resection)


  • • Nigro protocol of chemoradiation is first-line therapy


  • • Radiation therapy (XRT): 30 Gray to primary tumor and pelvic and inguinal nodes

    • Mitomycin is given on day 1 of XRT

    • Two 4-day infusions of 5-fluorouracil (5-FU) given on day 1 and day 28 of chemoradiation therapy

    • Cisplatin may be used in place of mitomycin

Treatment Monitoring

  • • Follow-up rectal and node exam


  • • Recurrence of disease

    • Metastatic disease


  • • Tumor size is best predictor

    • Mobile lesions < 2 cm have cure rates of 80%

    • Tumors > 5 cm associated with 50% mortality

    • Metastatic disease more likely to be present ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.